TIPP: responding to intense distress through the body
Explore four TIPP options for moments when distress makes thinking difficult. Choose safe ways to work with temperature, movement, breathing and muscle tension.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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TIPP: responding to intense distress through the body
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T — Temperature: brief cooling of the face
Check the medical cautions above first. If this option is suitable for you, briefly splash your face with cold water or place a cold pack wrapped in a cloth against your cheeks and around your eyes. Keep breathing normally and limit the cooling to around 30 seconds. Do not put your face underwater or hold your breath. Stop if you feel unwell.
TIPP is a distress tolerance skill from Marsha M. Linehan’s dialectical behaviour therapy (DBT) skills training. Reference: Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford Press.
I — Intense exercise: a short period of movement
If vigorous movement is safe for you, try a short activity that raises your effort, such as brisk marching on the spot for about a minute. Adapt the effort to your health and fitness rather than pushing through discomfort. Stop if you feel unwell; another TIPP option may suit you better.
P — Paced breathing: find a comfortable rhythm
Allow your breathing to become gentler and slower without forcing a deep breath. If comfortable, count four as you breathe in and six as you breathe out, roughly six breaths a minute. Let the breath out last slightly longer. Drop the counting and return to your usual breathing if you become dizzy or uncomfortable.
P — Paired muscle relaxation: release with the breath
Choose a comfortable muscle group, such as your hands or shoulders. As you breathe in, gently tighten it for a few seconds; as you breathe out, release the tension and silently say “relax”. Notice the difference before moving to another area. Avoid painful or injured areas and keep breathing throughout.
Choose suitable TIPP options
Select only options that are safe and workable for you. You can start with one. Keep your plan where you can find it easily, and include how to get support if the distress continues.
Rehearse and review TIPP
Practise when you feel settled, following the safety guidance. Record the distress level on either side of practice. A rating that stays the same is useful information too; discuss what to adapt or what support is needed.
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When to use ‘TIPP: responding to intense distress through the body’
‘TIPP: responding to intense distress through the body’ is an interactive dialectical behaviour therapy (DBT) worksheet. Consider this resource when exploring how a client responds to intense emotions, distress or relationship difficulties, and where acceptance or a change in response might fit.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 7 minutes. It moves through six short steps:
- T — Temperature: brief cooling of the face: Check the medical cautions above first. If this option is suitable for you, briefly splash your face with cold water or place a cold pack…
- I — Intense exercise: a short period of movement: If vigorous movement is safe for you, try a short activity that raises your effort, such as brisk marching on the spot for about a minute.…
- P — Paced breathing: find a comfortable rhythm: Allow your breathing to become gentler and slower without forcing a deep breath. If comfortable, count four as you breathe in and six as…
- P — Paired muscle relaxation: release with the breath: Choose a comfortable muscle group, such as your hands or shoulders. As you breathe in, gently tighten it for a few seconds; as you breathe…
- Choose suitable TIPP options: Select only options that are safe and workable for you. You can start with one. Keep your plan where you can find it easily, and include…
- Rehearse and review TIPP: Practise when you feel settled, following the safety guidance. Record the distress level on either side of practice. A rating that stays…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The DBT approach behind it
‘TIPP: responding to intense distress through the body’ draws on dialectical behaviour therapy (DBT). DBT brings acceptance and change together: recognising an experience as it is while considering a different response. Its skills include mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. These offer ways to notice what is happening, stay with difficult moments, understand emotions and communicate needs. The therapist and client can consider which skills fit the situation.
It is intended as one part of a wider course of therapy rather than as advice or a diagnosis. The therapist can help decide how it fits the work and discuss what emerges.
Evidence & sources
This worksheet draws on dialectical behaviour therapy. Key sources include:
- Linehan, M.M. (2015). DBT Skills Training Manual (2nd ed.). New York: Guilford Press.
- Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
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